Manager, Digital Claims Optimization

Workforce Classification: Telecommuter Join Our Team: Do Meaningful Work and Improve People’s Lives Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/ . About the role of the Manager, Digital Claims Optimization Help redefine how claims work gets done—at scale and with purpose. As the Manager, Digital Claims Optimization , you’ll lead the design and operational delivery of automation and AI-enabled workflow solutions that replace manual, repetitive work with reliable digital decisioning. You’ll partner across Product, Technology, and Configuration to build well-controlled process automations, performance dashboards, and data-driven improvements that shorten cycle times, strengthen accuracy, and elevate the member experience. This is a hands-on leadership role for someone who wants to build, not just manage—someone energized by solving complex operational problems through smart use of technology and motivated by advancing Premera’s values through thoughtful decisions and making healthcare work better for our members. The Manager, Digital Claims Optimization is responsible for transforming Claims Operations by translating business needs into scalable automation solutions and system enhancements. This role owns end-to-end operational delivery of automation initiatives—from process analysis and requirements definition through testing, implementation, and adoption into day-to-day workflows—and serves as the business owner for automation and enterprise changes impacting Claims Operations. Success in this role requires strong systems thinking, a data-driven mindset, and the ability to lead across teams, balancing hands-on solution development with coaching and developing a team to deliver impactful, sustainable outcomes. Note: Candidates that live within 30 miles of Mountlake Terrace, WA will be required to work hybrid. Impact that you will have: Drive the digitization and automation of priority Claims Operations workflows—using process automation and AI-enabled decisioning—to improve cycle time, accuracy, and customer experience. Design scalable, well-controlled automated workflows and decision paths that are aligned to operational needs and enterprise claims strategy. Build and maintain dashboards and operational reporting to measure workflow performance, automation effectiveness, and post-implementation outcomes. Use data to identify bottlenecks and continuously optimize workflows through targeted automation and process improvements. Own end-to-end delivery for claims automation and operational change (requirements, testing/UAT coordination, defect management, readiness sign-off, and implementation). Ensure strong governance by understanding and operating assigned internal controls and overseeing third parties (as applicable) in alignment with contracts and Premera standards. What you will bring: Bachelor’s degree in a technical or quantitative field (e.g., computer science, information systems, engineering, data analytics, or a related discipline) is preferred or 4 years of relevant experience (Required). 5 years of experience in the following areas (Required): Digitizing and automating operational workflows, or Application development in a business environment, or Data analysis and business intelligence reporting. 2 years of hands‑on experience in data analysis and reporting, including building and using dashboards and operational reports (e.g., Tableau, Power BI) (Required). 3 years of management experience, including accountability for delivery quality, team development, and leading teams through change (Required). Experience scaling automation across multiple workflows or operational areas using repeatable delivery patterns. Familiarity with claims operations or similar process‑driven domains. Experience building dashboards and operational reporting using Power BI, Tableau, or equivalent BI tools. Familiarity with SDLC practices and backlog or ticketing tools. Practical application of continuous improvement methods within automated operations. Demonstrated ability to operate at the intersection of business and technology, translating system or automation changes into practical, operational outcomes. Premera total rewards Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including: Medical, vision, and dental coverage with low employee premiums. Voluntary benefit offerings, including pet insurance for paw parents. Life and disability insurance. Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service. Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few. Generous paid time off to reenergize. Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees. Employee recognition program to celebrate anniversaries, team accomplishments, and more. For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement. Commuter perks make your trip to work less impactful on the environment and your wallet. Free convenient on-site parking. Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable. Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more. Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling. Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus. Equal employment opportunity/affirmative action: Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [email protected] or via phone at 425-918-4785. Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin . The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience. The salary range for this role is posted below; we generally target up to and around the midpoint of the range. National Salary Range: $118,900.00 - $202,100.00 National Plus Salary Range: $135,600.00 - $230,500.00 *National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska . We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.